| NPI | 1285706556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.004195) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110002076) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2020-11-30 |